Spondylolisthesis can be caused by congenital conditions or trauma-induced fractures (pars defect) in the posterior joint area of the vertebrae, as well as the weakening or breaking of the bone structure connecting the vertebrae.
What Symptoms Do Patients with Spondylolisthesis Exhibit?
Symptoms typically vary depending on the amount of joint deterioration, the level of disc wear, and the degree of degeneration. In advanced cases or patients with severe slippage from the outset, symptoms are generally present. Common symptoms observed in patients include:
- Lower back pain
- Sciatica-like pain radiating to the legs
- Deformity in the lower back and hip in very advanced cases
- Pain in the back of the thigh due to muscle tightness
Should Every Patient with Spondylolisthesis Undergo Surgery?
No. Non-surgical methods should be the first choice, especially for mild slippage. These include physical therapy techniques and injection treatments applied by Algology specialists. If these treatments do not yield results and the patient's symptoms become intolerable, surgical treatments should be considered. Advanced degrees of slippage, often seen at younger ages, typically require surgical treatment. Patients with no symptoms or only mild symptoms that do not limit daily activities can be monitored without surgery.
Which Patients Require Surgery for Spondylolisthesis?
Surgery should be considered in cases where non-surgical methods have failed. In elderly patients with spondylolisthesis, symptoms are usually due to severe vertebral wear, degeneration, and nerve compression. The nerve root can become severely compressed, causing intense leg pain. If these symptoms cannot be alleviated with non-surgical methods, surgery should be planned, as this condition tends to progress. External applications cannot stop the slippage or relieve the pressure on the nerve. Therefore, surgical treatment is often the best option for many patients with severe nerve compression. In children, especially in cases of advanced slippage, surgical intervention is often necessary. Early surgery will both halt the progression of the slippage and alleviate symptoms. When the degree of slippage reaches its final stage—meaning the upper vertebra is nearly falling off the one below or has completely dislocated (spondyloptosis)—the risks of surgery increase significantly.
How Is Spondylolisthesis Surgery Performed? What Techniques Are Used?
The goal of spondylolisthesis surgery is to stabilize the slipped vertebra with the vertebra below and ensure that the two vertebrae fuse together. The desired outcome is to return the vertebra to its anatomical position; however, this is not always possible in cases of severe slippage. Typically, pedicle screws are placed in the slipped vertebra and the vertebra below. In cases of severe slippage, if bone quality is not optimal or to achieve better vertebral restoration, screws may also be placed in the vertebra above or extended to the pelvic bone. To increase fusion rates, cages filled with the patient's own bone tissue are placed between the vertebral bodies. If the slippage is at the L5-S1 level, a bone graft or a titanium cage containing bone graft material may be placed, extending from the front body of the sacrum to the front body of the first lumbar vertebra.
Is It Necessary to Fully Realign the Vertebra in Severe Slippage?
No. In cases of severe slippage, systems called neuromonitors, which alert to signal loss in the nerves during surgery, must be used. Especially during the realignment of severe slippage in the L5-S1 region, there can be signal loss in the L5 nerve root. During the procedure, continuous monitoring with a neuromonitor is essential, and the reduction, i.e., the realignment process, should be halted as soon as the signals begin to decrease. The reduction should not be continued unless it is confirmed that there is no signal loss and the nerve root is not compressed. If the reduction continues despite signal loss or if such surgeries are performed without using a neuromonitor, patients may experience permanent nerve paralysis and persistent, severe leg pain that does not subside over time.